Morris Brown

Cost comparison : a desflurane-versus a propofol-based general anesthetic technique

The purpose of this study was to compare the cost of a desflurane-based with a propofol-based general anesthetic technique. Fifty ambulatory orthopedic surgery patients were randomly assigned to one of two groups. Premedication and induction of anesthesia were standardized in both groups. In Group I patients, anesthesia was maintained with a propofol infusion and nitrous oxide-oxygen and in Group II patients, with desflurane-oxygen. The techniques used were identical to those routinely used with these drugs by our practitioners. The actual drug acquisition costs for the maintenance periods were calculated and compared, as was the duration of the postanesthesia care unit (PACU) stay (Phase I + Phase II). The drug acquisition cost for the maintenance period of general anesthesia with our desflurane-based technique was

Multicenter study of contaminated percutaneous injuries in anesthesia personnel.

11.24/h and for our propofol-based technique,

Procaine spinal anesthesia: a pilot study of the incidence of transient neurologic symptoms

44.08/h. The length of PACU stay was not significantly different in the two groups. In conclusion, maintenance general anesthesia with our desflurane technique was considerably less expensive than with our propofol technique. PACU stay was not increased using desflurane as opposed to propofol in our study. Desflurane offers a cost effective alternative to propofol for ambulatory general anesthesia.

A safe dose of vasopressin for paracervical infiltration.

Background Anesthesia personnel are at risk for occupational infection with bloodborne pathogens from contaminated percutaneous injuries (CPIs). Additional information is needed to formulate methods to reduce risk. Methods The authors analyzed CPIs collected during a 2‐yr period at 11 hospitals, assessed CPI underreporting, and estimated risks of infection with human immunodeficiency virus and hepatitis C virus. Results Data regarding 138 CPIs were collected: 74% were associated with blood‐contaminated hollow‐bore needles, 74% were potentially preventable, 30% were considered high‐risk injuries from devices used for intravascular catheter insertion or obtaining blood, and 45% were reported to hospital health services. Corrected for injury underreporting, the CPI rate was 0.27 CPIs per yr per person; per full‐time equivalent worker, there were 0.42 CPIs/yr. The estimated average 30‐yr risks of human immunodeficiency virus or hepatitis C virus infection per full‐time equivalent are 0.049% and 0.45%, respectively. Projecting these findings to all anesthesia personnel in the United States, the authors estimate that there will be 17 human immunodeficiency virus infections and 155 hepatitis C virus infections in 30 yr. Conclusions Performance of anesthesia tasks is associated with CPIs from blood‐contaminated hollow‐bore needles. Thirty percent of all CPIs would have been high‐risk for bloodborne pathogen transmission if the source patients were infected. Most CPIs were potentially preventable, and fewer than half were reported to hospital health services. The results identify devices and mechanisms responsible for CPIs, provide estimates of risk levels, and permit formulation of strategies to reduce risks.

Perioperative Anesthetic Management of a Patient with Long Q-T Syndrome (LQTS)

STUDY OBJECTIVES To determine the approximate incidence of transient neurologic symptoms (TNS) [formerly known as transient radicular irritation (TRI)] associated with procaine spinal anesthesia, and whether fentanyl prolongs the duration of procaine spinal anesthesia. DESIGN Unrandomized pilot study. SETTING Community teaching hospital. PATIENTS 106 consecutive patients scheduled for spinal anesthesia for procedures anticipated to last less than 90 minutes. INTERVENTIONS All patients received 5% procaine for spinal anesthesia. Fentanyl 20 micrograms was added for procedures anticipated to last longer than 45 minutes (but less than 90 min). Intraoperatively the adequacy of duration, level, and intensity of anesthesia were observed. Time from injection of local anesthetic until knee-bending was recorded. Three days postoperatively, patients were questioned intensively in an effort to determine whether back pain and/or symptoms consistent with TNS had occurred. MEASUREMENTS AND MAIN RESULTS Duration of anesthesia was adequate in all but one instance. The intensity and the sensory level of anesthesia were satisfactory with one exception, a woman who had an unexpectedly low sensory level (L1) after 60 mg of procaine for cerclage, and who was also was the only patients to develop TNS. The incidence of TNS (0.9%) was markedly less than that reported after lidocaine and similar to the incidence observed after bupivacaine. Mild back pain without radiation occurred in 11 patients (10%), an incidence that is similar to that seen after bupivacaine and lidocaine. Compared with procaine alone, the addition of fentanyl significantly (p = 0.0001) prolonged the time to bending knees from 72 minutes to 97 minutes. CONCLUSIONS Procaine may be a useful alternative to lidocaine for short procedures, and it is less likely to produce TNS. Fentanyl prolongs motor block when added to procaine.

Noninvasive oxygen monitoring.

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